极低出生体重儿外周中心静脉置管导管相关血流感染的病原学及临床特点  

Pathogen profile and clinical characteristics of catheter-related bloodstream infectionin very low birth weight infants

作　　者：华敏敏[1] 夏磊[1] 张彦华[1] 徐发林[1] Hua Minmin;Xia Lei;Zhang Yanhua;Xu Falin(Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,郑州450052

出　　处：《中华新生儿科杂志（中英文）》2022年第6期505-509,共5页Chinese Journal of Neonatology

摘　　要：目的探讨极低出生体重儿经外周中心静脉置管(peripherally inserted central venous catheter, PICC)导管相关血流感染(catheter-related bloodstream infections, CRBSI)的病原学及临床特点。方法选择2018年11月至2021年10月郑州大学第三附属医院新生儿重症监护病房收治的PICC后发生CRBSI的极低出生体重儿进行回顾性研究, 分析病原菌分布及耐药性。将细菌感染的患儿分为革兰阴性(G-)菌组和革兰阳性(G+)菌组, 比较两组患儿的一般情况、PICC留置时间、留置部位、感染时体重、脂肪乳和预防性抗生素使用情况、临床表现及实验室检查结果。结果共纳入70例CRBSI患儿, 检出70株病原菌。G-菌占50.0%(35/70), 以肺炎克雷伯菌(34.3%, 12/35)和粘质沙雷菌(34.3%, 12/35)为主, 肺炎克雷伯菌耐药更严重;G+菌占47.1%(33/70), 主要为表皮葡萄球菌(45.5%, 15/33), 大多为耐甲氧西林菌株(86.7%, 13/15), 蜡样芽孢杆菌仅占6.1%(2/33), 但2例蜡样芽孢杆菌CRBSI均导致患儿很快死亡;真菌占2.9%(2/70)。患儿主要临床表现为呼吸暂停, 最常见的并发症为休克, G+菌组与G-菌组在临床表现、实验室检查及预后方面的差异均无统计学意义(P>0.05), 但G+菌组胎龄、感染时脂肪乳用量均大于G-菌组, 感染时体重小于G-菌组, 差异有统计学意义(P<0.05)。结论新生儿重症监护病房极低出生体重儿PICC引起的CRBSI多为条件致病菌, 根据临床表现及常规生化检查难以判断感染菌种, 但胎龄较大、体重较小、脂肪乳用量较大者更易感染G+菌。Objective To study the pathogen profile and clinical characteristics of catheter-related bloodstream infection(CRBSI)in very low birth weight infants(VLBWI)receiving peripherally inserted central venous catheter(PICC).Methods From November 2018 to October 2021,VLBWI with CRBSI after PICC admitted to neonatal intensive care unit(NICU)of our hospital were retrospectively studied.The pathogen profile and drug resistance characteristics were analyze.The infants with bacterial infection were assigned into gram-negative(G-)group and gram-positive(G+)group.Their general status,PICC duration and the site of PICC,body weight at infection,use of lipid emulsion and prophylactic antibiotics,clinical manifestations and laboratory results were compared between the two groups.Results A total of 70 infants with CRBSI were included and 70 strains of pathogenic bacteria were detected.50.0%(35/70)were G-bacteria with klebsiella pneumoniae(34.3%,12/35)and serratia marcescens(34.3%,12/35)as the most common bacteria.Klebsiella pneumoniae showed more severe drug resistance.47.1%(33/70)were G+bacteria and the most common strain was staphylococcus epidermidis(45.5%,15/33)with a majority of methicillin-resistant(86.7%,13/15).2 cases(6.1%,2/33)had bacillus cereus infection and both suffered quick death.2.9%(2/70)were fungi infection.The main clinical manifestation of CRBSI in VLBWI was apnea and shock was the most common complication.G+group showed significantly higher gestational age and lipid emulsion usage but lower body weight than G-bacteria group.No significant differences existed in clinical manifestations,laboratory results and prognosis between the two groups.Conclusions Most pathogens causing CRBSI in VLBWI with PICC are opportunistic pathogens.It is difficult to differentiate G+and G-bacterial infection based on clinical manifestations and laboratory results.However,VLBWI with higher gestational age and lipid emulsion usage but lower body weight are more susceptible to G+bacterial infection.

关 键 词：婴儿 极低出生体重 中心静脉置管 导管相关血流感染 病原菌 临床特点 

分 类 号：R722.1[医药卫生—儿科] R446.5[医药卫生—临床医学]